1. Ophthal Plast Reconstr Surg. 2015 Nov 11. [Epub ahead of print]

Extranodal Rosai-Dorfman Disease of the Orbit: Clinical Features of 8 Cases.

Tan JJ(1), Narang S, Purewal B, Langer PD, Blaydon S, Schwarcz RM, McCormick SA, 
Kim JY, Walrath JD, Burt BO, Shinder R.

Author information: 
(1)*Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, New
York; †Department of Ophthalmology, Rutgers Biomedical and Health Sciences,
Newark, New Jersey; ‡Texas Oculoplastic Consultants, Austin, Texas; §OculoFacial 
Plastic & Reconstructive Surgery Division, Albert Einstein College of Medicine
and Montefiore Medical Center, Bronx, New York; ‖Department of Pathology, New
York Eye & Ear Infirmary, New York, New York; ¶Department of Ophthalmology, Emory
University Hospital, Atlanta, Georgia; and #Texas Tech University Health Sciences
Center, El Paso, Texas, U.S.A.

PURPOSE: To report on the presentation, radiography, histology, and treatment of 
8 cases of extranodal Rosai-Dorfman disease involving the orbit.
METHODS: Multicenter retrospective case series.
RESULTS: Five males and 3 females had a median age of 10 years (range 2-78
years). Presenting signs and symptoms included proptosis, periorbital pain,
palpable mass, blepharoptosis, decreased vision, diplopia, impaired extraocular
motility, and afferent pupillary defect. Four patients had bilateral orbital
disease, while 4 had unilateral disease. Six cases were extraconal, 1 was
intraconal, and 1 was both intra- and extra-conal. Four cases had only extranodal
disease without lymphadenopathy (3 of which had localized orbital disease).
Diagnosis was confirmed by exam, orbital, and/or systemic radiography, and biopsy
in all cases. Treatment strategies included excision or debulking, systemic
corticosteroids, chemotherapy, radiotherapy, observation or a combination
thereof. At last follow up, 4 patients were disease free, while 4 had residual
improved disease.
CONCLUSIONS: Rosai-Dorfman disease of the orbit is a rare clinical entity. Purely
extranodal disease is rare, with isolated orbital disease being exceedingly rare.
This study is unique in that 4 of 8 patients had strictly isolated extranodal
disease of the orbit. A large majority of the cases had disease in the extraconal
space, contrasting with previous reports. In addition, lacrimal gland disease,
particularly bilateral involvement, was prominent in the current study. Although 
there is no consensus on treatment, surgical excision should be attempted if
plausible in symptomatic patients especially if the orbit represents a localized 
site of disease.

PMID: 26561955   [PubMed - as supplied by publisher]


2. Ophthal Plast Reconstr Surg. 2015 Nov 11. [Epub ahead of print]

Uniformly Sclerotic Diffuse Large B-Cell Lymphoma of the Orbit.

Jakobiec FA(1), Stagner AM, Lefebvre DR.

Author information: 
(1)*David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye & Ear
Infirmary, Boston, Massachusetts; †Department of Ophthalmology, Harvard Medical
School, Boston, Massachusetts; and ‡Ophthalmic Plastic Surgery Service,
Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, U.S.A.

Over a year, a 51-year-old man developed a mass in the anteromedial orbit in the 
region of the lacrimal sac that caused epiphora. Imaging studies disclosed no
bone destruction. On biopsy, a sclerotic lesion was discovered populated by
hyperchromatic cells that had been apparently distorted by crush artifact,
indicative of fragile cells. The lesion simulated a sclerosing inflammatory
process or a desmoplastic metastatic carcinoma. CD20 revealed that the background
cells were large neoplastic B-lymphocytes. A systemic workup uncovered widespread
skeletal disease. The patient is undergoing R-CHOP chemotherapy with a relatively
favorable prognosis due to negative testing for MYC.

PMID: 26561954   [PubMed - as supplied by publisher]


3. Ophthal Plast Reconstr Surg. 2015 Nov 11. [Epub ahead of print]

Ocular Trauma: Automatic Nail Gun.

Naysan J(1), Rodgers R.

Author information: 
(1)*Department of Ophthalmology, North Shore - Long Island Jewish Health System, 
Great Neck, New York; and †Hofstra North Shore - Long Island Jewish School of
Medicine, Hempstead, New York, U.S.A.

PMID: 26561953   [PubMed - as supplied by publisher]


4. Ophthal Plast Reconstr Surg. 2015 Nov-Dec;31(6):427-36. doi:
10.1097/IOP.0000000000000504.

Management of Orbital and Periocular Vascular Anomalies.

Stacey AW(1), Gemmete JJ, Kahana A.

Author information: 
(1)*Department of Ophthalmology and Visual Sciences, Kellogg Eye Center,
University of Michigan, and †Department of Radiology, University of Michigan, Ann
Arbor, Michigan, U.S.A.

PURPOSE: To review the treatment modalities available to clinicians who treat
orbital and periocular vascular anomalies, with a focus on newer approaches.
METHODS: The authors' experience, along with a literature review, was used to
provide a concise summary of the available approaches to the treatment of
periocular vascular anomalies. Emerging diagnostic tools and therapies are
highlighted.
RESULTS: The treatment of orbital and periocular vascular anomalies, including
vascular malformations and tumors, increasingly utilizes a multidisciplinary team
and a combination of endovascular, percutaneous, and open surgical techniques.
CONCLUSIONS: A growing reliance on new instrumentation and tools in a
team-oriented approach to treatment may lead to better results with improved
visual function and cosmesis and with reduced risk of complications.

PMID: 26560200   [PubMed - in process]


5. Ophthal Plast Reconstr Surg. 2015 Nov-Dec;31(6):494. doi:
10.1097/IOP.0000000000000529.

A Technique for Removal of Nasal Silastic Tubing After Lacrimal Surgery.

Putterman AM(1).

Author information: 
(1)Chicago, IL, U.S.A., drputterman@drputterman.com.

PMID: 26555210   [PubMed - in process]


6. Ophthal Plast Reconstr Surg. 2015 Nov-Dec;31(6):492-4. doi:
10.1097/IOP.0000000000000519.

A Stitch in Time….

Mukherjee B.

PMID: 26555209   [PubMed - in process]


7. Ophthal Plast Reconstr Surg. 2015 Nov-Dec;31(6):492. doi:
10.1097/IOP.0000000000000517.

Dacryocystitis and Failure of Dacryocystorhinostomy Associated with Tamsulosin.

Chen Y, Thyparampil PJ, Yen MT.

PMID: 26555208   [PubMed - in process]


8. Ophthal Plast Reconstr Surg. 2015 Nov-Dec;31(6):491. doi:
10.1097/IOP.0000000000000571.

Reply re: "Cosmetic Microdroplet Botulinum Toxin A Forehead Lift: A New Treatment
Paradigm".

Steinsapir KD.

PMID: 26555207   [PubMed - in process]


9. Ophthal Plast Reconstr Surg. 2015 Nov-Dec;31(6):490-1. doi:
10.1097/IOP.0000000000000570.

Re: "Cosmetic Microdroplet Botulinum Toxin A Forehead Lift: A New Treatment
Paradigm".

Holds JB.

PMID: 26555206   [PubMed - in process]


10. Ophthal Plast Reconstr Surg. 2015 Nov-Dec;31(6):490. doi:
10.1097/IOP.0000000000000560.

Reply re: "Electron Microscopic Features of Nasal Mucosa Treated with Topical and
Circumostial Injection of Mitomycin-C: Implications in Dacryocystorhinostomy".

Ali MJ, Baig F, Lakshman M, Naik MN.

PMID: 26555205   [PubMed - in process]


11. Ophthal Plast Reconstr Surg. 2015 Nov-Dec;31(6):489. doi:
10.1097/IOP.0000000000000559.

Re: "Electron Microscopic Features of Nasal Mucosa Treated with Topical and
Circumostial Injection of Mitomycin C: Implications in Dacryocystorhinostomy".

Tawfik HA.

PMID: 26555204   [PubMed - in process]


12. Ophthal Plast Reconstr Surg. 2015 Nov-Dec;31(6):488-9. doi:
10.1097/IOP.0000000000000574.

Reply re: "Stop Blaming the Septum".

Schwarcz R, Fezza JP, Jacono A, Massry GG.

PMID: 26555203   [PubMed - in process]


13. Ophthal Plast Reconstr Surg. 2015 Nov-Dec;31(6):487-8. doi:
10.1097/IOP.0000000000000569.

Re: "Stop Blaming the Septum".

Steinsapir KD.

PMID: 26555202   [PubMed - in process]


14. Ophthal Plast Reconstr Surg. 2015 Nov-Dec;31(6):486-7. doi:
10.1097/IOP.0000000000000551.

Reply re: "Quantitive Assessment of Optic Nerve with Diffusion Tensor Imaging in 
Patients with Thyroid Orbitopathy".

Ozkan B, Anik Y, Katre B, Altintaş Ö, Gençtürk M, Yüksel N.

PMID: 26555201   [PubMed - in process]


15. Ophthal Plast Reconstr Surg. 2015 Nov-Dec;31(6):486. doi:
10.1097/IOP.0000000000000550.

Re: "Quantitative Assessment of Optic Nerve with Diffusion Tensor Imaging in
Patients with Thyroid Ophthalmopathy".

Lee H(1), Baek S, Seo HS.

Author information: 
(1)Department of Ophthalmology Korea University College of Medicine Ansan,
Republic of Korea Department of Ophthalmology Korea University College of
Medicine Seoul, Republic of Korea Department of Radiology Korea University
College of Medicine Ansan, Republic of Korea.

PMID: 26555200   [PubMed - in process]


16. Ophthal Plast Reconstr Surg. 2015 Oct 30. [Epub ahead of print]

Orbital Complication Following Calcium Hydroxylapatite Filler Injection.

Dagi Glass LR(1), Choi CJ, Lee NG.

Author information: 
(1)Ophthalmic Plastic Surgery, Department of Ophthalmology, Massachusetts Eye and
Ear Infirmary, Boston, Massachusetts, U.S.A.

Cosmetic facial fillers have gained immense popularity in recent years. Although 
some patients opt to undergo an injection over surgery in light of the risks of
an operation, there have been numerous reports of complications from these
injections, including blindness. It is thought that filler particles can migrate 
within an artery and become emboli within small vessels. This case of focal
orbital inflammation and dysmotility as a consequence of calcium hydroxylapatite 
filler injection in the face has not yet been documented in the literature.

PMID: 26524160   [PubMed - as supplied by publisher]


17. Ophthal Plast Reconstr Surg. 2015 Oct 30. [Epub ahead of print]

Severe Pediatric Thyroid Eye Disease: Surgical Case Series.

Wu CY(1), Elner VM, Kahana A.

Author information: 
(1)Department of Ophthalmology and Visual Sciences, WK Kellogg Eye Center,
University of Michigan, Ann Arbor, Michigan, U.S.A.

Thyroid eye disease (TED) usually has mild manifestations in pediatric patients, 
and orbital decompression is rarely necessarily. The authors present the clinical
course of 3 pediatric patients age 16 or younger at the time of decompression
surgery with severe orbitopathy. Case 1 is a 9-year-old prepubertal
Asian-American female with Graves' disease and TED who underwent balanced
decompression for compressive optic neuropathy. Case 2 is a 14-year-old Caucasian
female with Graves' disease and TED who underwent balanced decompression for
compressive optic neuropathy, stretch optic neuropathy, and globe subluxation.
Case 3 is a 14-year-old African-American male with unilateral euthyroid TED who
underwent staged right-sided lateral, medial, and floor decompressions for
asymmetric proptosis. All cases also had disfiguring proptosis and exposure
keratopathy, and in all cases, surgery successfully ameliorated the indications. 
Children, both pre- and post-pubertal, can rarely manifest visually threatening
severe orbitopathy due to TED. This represents the first reports of
thyroid-related optic neuropathy and globe subluxation in pediatric patients.
Further studies examining the mechanism responsible for the disparities in
pediatric and adult TED are warranted.

PMID: 26524159   [PubMed - as supplied by publisher]


18. Ophthal Plast Reconstr Surg. 2015 Jul 8. [Epub ahead of print]

Histopathology, Immunohistochemistry, and Electron Microscopic features of a
Dacryocystorhinostomy Ostium Cicatrix.

Ali MJ(1), Mishra DK, Baig F, Naik MN.

Author information: 
(1)*Dacryology Service, †Ocular Pathology Service, L.V. Prasad Eye Institute,
Hyderabad; and ‡Department of Pathology, Global Hospitals, Hyderabad, India.

PURPOSE: The aim of this study is to report the histopathological,
Immunohistochemical, and ultrastructural features of a dacryocystorhinostomy
ostium cicatrix.
METHODS: A prospective histopathological study was performed in a tertiary eye
care setting. Scarred nasal mucosal tissues obtained during endoscopic revisions 
of 10 previously failed dacryocystorhinostomies secondary to complete cicatricial
closure of the ostia were studied. The tissue specimens were analyzed using
hematoxylin and eosin, periodic acid-Schiff staining. Special stains used include
Masson's trichrome and Alizarin red. Immunohistochemistry was performed using
vimentin, smooth muscle actin, CD3, CD5, and CD20. Specimens were processed for
ultrastructural analysis as per standard protocols for transmission electron
microscopy.
RESULTS: The respiratory epithelial regeneration was noted to be complete.
Irregular laying of deeply eosinophilic and hyalinized collagen with intervening 
fibroblasts was noted. Focal areas of new bone formation were seen within the
cicatricial tissue with osteocytes and ongoing osteoblastic rimming. The
infiltrates were mixture of both T and B lymphocytes and were positive for CD3,
CD5, and CD20 immunostaining. Electron microscopy showed disorganized collagen
fibrils with numerous fibroblasts and mononuclear inflammatory infiltrate.
Amorphous bony osteoid within a fibrillar background with metabolically active
osteoblasts showed a vesicular cytoplasm, hyperplastic proliferating
mitochondria, large Golgi apparatus, and dense endoplasmic reticulum.
CONCLUSION: There is new bone formation within the dense connective tissues of a 
dacryocystorhinostomy cicatrix. This study may provide useful inputs for further 
basic science studies aimed at better understanding of wound healing in failed
dacryocystorhinostomy.

PMID: 26517203   [PubMed - as supplied by publisher]


19. Ophthal Plast Reconstr Surg. 2015 Oct 26. [Epub ahead of print]

Extreme Eyelid Lymphedema Associated with Rosacea (Morbihan Disease): Case
Series, Literature Review, and Therapeutic Considerations.

Carruth BP(1), Meyer DR, Wladis EJ, Bradley EA, Al-Rohil R, Jones DM, Bartley GB.

Author information: 
(1)*Ophthalmic Plastic Surgery, Lions Eye Institute, Albany Medical College,
Slingerlands, New York; †Department of Ophthalmology, Mayo Clinic and Mayo
Foundation, Rochester, Minnesota; and ‡Department of Pathology, Albany Medical
College, Albany, New York, U.S.A.

PURPOSE: To describe severe lymphedema of the eyelids, known as Morbihan disease,
a previously characterized but infrequently reported and poorly understood entity
related to rosacea that features solid mid-facial and eyelid lymphedema.
METHODS: Retrospective chart review, histopathologic and immunohistochemical
analysis, and pertinent literature consideration.
RESULTS: Five cases of Morbihan disease were identified. Histopathologic
examination revealed pleomorphic perivascular and perilymphatic inflammation with
profound lymphangiectasis and lymph stasis, thus suggesting elements of both
rosacea and localized, chronic lymphedema. Multiple therapeutic interventions
were performed including systemic anti-inflammatory therapy, surgical debulking, 
and corticosteroid injection.
CONCLUSIONS: Extreme eyelid edema associated with characteristic skin changes and
histopathologic findings represents an entity known as Morbihan disease which is 
rare and difficult to treat. While multiple modalities have been employed with
variable results, future therapeutic considerations may include the use of
targeted biologic agents.

PMID: 26505236   [PubMed - as supplied by publisher]


20. Ophthal Plast Reconstr Surg. 2015 Oct 26. [Epub ahead of print]

Primary Extradural Ectopic Orbital Meningioma.

Tendler I(1), Belinsky I, Abramson DH, Marr BP.

Author information: 
(1)*Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York
New York; and †Department of Ophthalmology, Weill Cornell Medical College, New
York, New York, U.S.A.

The authors describe a rare case of a primary extradural ectopic meningioma
occurring in a 9-year-old female. A review of the literature with respect to
clinical presentation, radiographic findings, management, and outcome among
similar cases is discussed. Common features that may assist with diagnosing this 
unusual tumor include absence of bone or optic nerve sheath involvement,
presentation at a young age, occurrence in the medial orbit, and sinus asymmetry 
on radiographic imaging. Preferred method of treatment is complete surgical
excision.

PMID: 26505235   [PubMed - as supplied by publisher]


21. Ophthal Plast Reconstr Surg. 2015 Oct 26. [Epub ahead of print]

Maxillary Ameloblastoma with Orbital Involvement: An Institutional Experience and
Literature Review.

Milman T(1), Lee V, LiVolsi V.

Author information: 
(1)*Department of Pathology and Laboratory Medicine, Hospital of the University
of Pennsylvania, Perelman School of Medicine, and †Department of Ophthalmology,
Scheie Eye Institute, Philadelphia, Pennsylvania, U.S.A.

PURPOSE: To describe 8 patients with orbital involvement by ameloblastoma and to 
review the literature on this topic.
METHODS: The electronic medical records and pathology databases of the Hospital
of the University of Pennsylvania were searched to identify all patients with
histopathologically confirmed ameloblastoma diagnosed between 1990 and 2015.
PubMed database was searched for all well-documented cases of maxillary
ameloblastoma and ameloblastic carcinoma ex-ameloblastoma with orbital
involvement published in the English literature. The information collected on the
compiled 23 patients included age, sex, clinical presentation, imaging findings, 
management, tumor histopathologic features, and follow up.
RESULTS: Review of medical records identified 8 patients with orbital involvement
by ameloblastoma. Literature search yielded 15 patients with well-documented
orbital involvement by ameloblastoma. Most tumors occurred in men (19 of 23, M:F 
= 4-5:1) with an average age of 56 years. The overall rates of recurrence, visual
compromise, death, and confirmed disease-related mortality were 70% (16/23), 26% 
(6/23), 39% (9/23), and 22% (5/23), respectively. The initial surgical approach
correlated with prognosis. The rates of recurrence, orbital exenteration, and
mortality in the cohort managed with conservative surgery or partial maxillectomy
were 57% (8/14), 29% (4/14), and 50% (7/14), respectively. In contrast, the
patients initially managed with a radical resection had substantially lower
frequencies of tumor recurrence (2/7, 29%), exenteration (1/7, 14%), and death
(1/7, 14%). Malignant transformation to ameloblastic carcinoma occurred in the
setting of recurrent disease in 3 patients and in 1 patient with prolonged
duration of symptoms, suggestive of a long-standing tumor.
CONCLUSIONS: Maxillary ameloblastoma can rarely involve the orbit, leading to
significant ocular morbidity and occasional mortality. Prompt radical resection
of the tumor has the potential to decrease the likelihood of recurrence and
visual compromise, and can improve survival.

PMID: 26505234   [PubMed - as supplied by publisher]


22. Ophthal Plast Reconstr Surg. 2015 Oct 26. [Epub ahead of print]

Metastatic Embryonal Conjunctival Rhabdomyosarcoma in a 4-Year-Old Boy.

Sezenöz AS(1), Karalezli A, Özkan Arat Y, Çoban G, Kiratli H, Terzi A.

Author information: 
(1)*Department of Ophthalmology, Başkent University, Ankara, Turkey; †Department 
of Ophthalmology, Muğla Sıtkı Koçman University, Muğla, Turkey; ‡Department of
Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin,
U.S.A.; §Department of Radiology, Başkent University, Konya, Turkey; ║Department 
of Ophthalmology, Hacettepe University, Ankara, Turkey; and ¶Department of
Pathology, Başkent University, Ankara, Turkey.

The authors report the case of a 4-year-old boy who presented with unilateral
ptosis and a mass lesion of palpebral conjunctiva of the left upper eyelid, that 
had been present for 2 weeks, and had rapidly enlarged. The lesion was salmon
colored and was easily distinguished from the conjunctiva. There was no obvious
orbital extension in the MRI studies. Excisional biopsy was performed through a
conjunctival approach. The histopathology was consistent with embryonal
rhabdomyosarcoma. Thoracoabdominal CT scans revealed nodules in both lungs,
indicating stage 4 disease. The patient received chemotheraphy and
intensity-modulated radiation therapy. Rhabdomyosarcoma confined to the
conjunctiva and distant metastasis without orbital involvement is rare. It should
be included in the differential diagnosis of any atypical conjunctival mass
lesions in children, and histopathology is necessary to establish proper
treatment. As the case indicates, detailed systemic evaluation and careful
systemic follow up of these patients are mandatory.

PMID: 26505233   [PubMed - as supplied by publisher]


23. Ophthal Plast Reconstr Surg. 2015 Oct 26. [Epub ahead of print]

Nylon Hang Back Sutures in the Repair of Secondary Ptosis Following Overcorrected
Dysthyroid Upper Eyelid Retraction.

Shah-Desai S(1), Azarbod P, Szamocki S, Rose GE.

Author information: 
(1)*Barking Havering Redbridge University Hospitals NHS Trust, Essex, England;
and †Moorfields Eye Hospital, London, United Kingdom.

PURPOSE: Repair of blepharoptosis secondary to surgical overcorrection of thyroid
related primary upper eyelid retraction (secondary ptosis) can be unpredictable. 
This study describes the long-term results of "hang-back" nylon sutures, for an
anterior approach surgical repair of secondary ptosis.
METHODS: This was a retrospective consecutive case note review of patients
referred with secondary ptosis (after prior upper eyelid lowering for thyroid eye
disease), under the care of a single surgeon at Moorfields Eye Hospital &
subsequently at Barking Havering Redbridge University Hospitals NHS Trust (SSD). 
In accordance with hospital trust policy, this audit was registered and all
patient data was anonymized, ethical approval was not required. Patients with
secondary ptosis underwent surgery under local anesthesia through an upper eyelid
skin-crease incision. The anterior portion of the levator muscle was freed from
all scar tissues and its action re-established on the superior part of the upper 
tarsal plate, using two 6-0 nylon hang-back sutures placed centrally and
medially. The margin reflex distance 1 (MRD1), skin crease height, eyelid
contour, symmetry of eyelid position (difference in margin reflex distance 1 <1
mm in both eyes) and degree of lagophthalmos were assessed from clinical notes
preoperative and postoperatively at 1, 3, and 12 months.
RESULTS: Surgery was undertaken in 14 eyelids in 13 patients (3 males; 23%), with
9/14 (65%) eyelids having undergone attempted repair of ptosis prior to referral;
in 7 of the 8 (88%) eyelids with previous failed ptosis repair, the referring
surgeon had used soluble hang-back sutures. As compared with an average
preoperative margin reflex distance 1 of 0.9 mm (median 1, range: -1 to 2 mm),
the average margin reflex distance 1 at 3 months was 3.0 mm (median 3, range:
2.5-4 mm; p < 0.0001) and 2.8 mm at 12-month follow up (median 3, range: 2-4mm; p
< 0.0001). The upper eyelid central skin crease height changed from a
preoperative mean of 9.8 mm (median 9, range: 5-15 mm) to 8.7 mm at 3 months
(median 8, range: 7-12 mm; p = 0.1412) and 8.9 mm at 12-month follow up (median
9, range: 7-11 mm; p = 0.2930). Only 3 patients had postoperative lagophthalmos
(one patient 3 mm and two patients 1 mm) at 3 months after surgery, this
resolving by the 12-month postoperative visit. Thirteen cases (93%) had a good
functional, symmetrical, and aesthetic result at 12 month follow up, with a late 
recurrence of ptosis in 1 patient (7%).
CONCLUSION: The "hang-back" semi-permanent suture technique for repair of
over-corrected upper eyelid lowering in thyroid eye disease appears to provide an
excellent and predictable long-term result with a low incidence of late
recurrence of ptosis.

PMID: 26505232   [PubMed - as supplied by publisher]


24. Ophthal Plast Reconstr Surg. 2015 Oct 26. [Epub ahead of print]

Frontalis Muscle Asymmetry and Lateral Landmarks.

Costin BR(1), Wyszynski PJ, Rubinstein TJ, Choudhary MM, Chundury RV, McBride JM,
Levine MR, Perry JD.

Author information: 
(1)*Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; †Department of
Biology, John Carroll University, University Heights, Ohio; ‡Department of
Anatomy, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio; and
§Lorain Institute, Cleveland Clinic, Lorain, Ohio, U.S.A.

PURPOSE: To investigate frontalis muscle asymmetry and characterize its lateral
interdigitation with the orbicularis oculi muscle.
METHODS: After making a mid-coronal incision and bluntly dissecting to the
orbital rim, the frontalis muscle was exposed, marked, and photographed. The
right and left muscle bellies were analyzed and compared in both pixels and cm
ratios generated with NIH ImageJ software. A ratio of ≥1.5 was considered
significantly asymmetric. The lateral interdigitation of the frontalis and
orbicularis oculi muscles was measured from the supraorbital notch with a metric 
ruler. Data were analyzed using 2-sample t tests, paired t tests, log scales, and
nonparametric tests were performed for sensitivity analyses. A p value of ≤0.05
was considered statistically significant.
RESULTS: Fifty-eight hemifaces of 29 Caucasian cadavers were studied for muscle
belly asymmetry. Thirty-six hemifaces of 18 Caucasian cadavers (9 males) were
dissected for lateral landmarks and average age of these specimens was 73 years
(range: 35-91 years). Significant asymmetry in muscle belly area was found in
6/29 (20%) specimens, with the right muscle belly larger in all 6 specimens. On
average, the right muscle belly area was 1.23 times that of the left (p =
<0.001). The average frontalis-orbicularis interdigitation occurred 3.4 cm
lateral to the supraorbital notch.
CONCLUSIONS: Significant frontalis muscle belly asymmetry exists in 20% of
Caucasians cadavers. The right muscle belly was larger on average and in all
cases of significant asymmetry. The frontalis muscle interdigitates with the
orbicularis oculi on average 3.4 cm lateral to the supraorbital notch.

PMID: 26505231   [PubMed - as supplied by publisher]


25. Ophthal Plast Reconstr Surg. 2015 Oct 26. [Epub ahead of print]

Safety and Effectiveness of a Small Incision Lateral Eyebrow Ptosis Repair
Technique Using a Frontalis Muscle Transposition Flap.

Ganapathy PS(1), Chundury RV, Perry JD.

Author information: 
(1)Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.

PURPOSE: To evaluate the safety and effectiveness of a frontalis muscle
transposition flap for treatment of lateral eyebrow ptosis.
METHODS: The charts of all patients undergoing frontalis muscle transposition
flap eyebrow ptosis repair from December 2013 to September 2014 were reviewed.
Charts with inadequate photographs were excluded. Charts were reviewed for
demographics, preoperative and postoperative photographs, surgical technique, and
complications. The following parameters were assessed on preoperative and
postoperative photographs: corneal diameter, central brow height, and lateral
brow height. Measurements were normalized to a standard corneal diameter of 11.5 
mm. Statistical analysis was performed in conjunction with the Cleveland Health
Institute Biostatistics Department.
RESULTS: Forty-six total patients underwent frontalis muscle transposition flap
eyebrow ptosis repair and the charts of 31 patients (53 cases) were reviewed.
There were 20 female and 11 male patients. Average age was 69.1 ± 7.7 years
(range: 50 - 86 years). There were 9 unilateral and 22 bilateral cases.
Concomitant surgeries included upper blepharoplasty (33 cases),
conjunctival-Mullerectomy blepharoptosis repair (3 cases), and intralesional
tetracycline injection for festoons (3 cases). Average follow-up interval between
surgery and the final postoperative photograph was 10.2 weeks (range: 6-26
weeks). Overall, lateral brow height increased postoperatively by 1.78 mm (p <
0.05). In patients that underwent frontalis muscle transposition flap alone,
lateral brow height increased by 2.86 mm (p < 0.05). Scalp hypesthesia was
documented in 10/31 patients, and resolved in 8/10 patients at last follow up.
CONCLUSIONS: A frontalis muscle transposition flap effectively addresses lateral 
eyebrow ptosis repair through a small, relatively concealed incision. It produces
temporary scalp hypesthesia in a significant number of patients, and long-term
results remain unknown.

PMID: 26505230   [PubMed - as supplied by publisher]


26. Ophthal Plast Reconstr Surg. 2015 Oct 26. [Epub ahead of print]

Upper Eyelid Fractional CO2 Laser Resurfacing With Incisional Blepharoplasty.

Kotlus BS(1), Schwarcz RM, Nakra T.

Author information: 
(1)*Private Practice, New York, New York; †Albert Einstein College of Medicine,
Bronx, New York, New York; and ‡Texas Oculoplastic Consultants, Austin, Texas,
U.S.A.

PURPOSE: Laser resurfacing, performed at the same time as blepharoplasty, has
most commonly been applied to the lower eyelid skin but can effectively be used
on the upper eyelid to reduce rhytidosis and improve skin quality. The authors
evaluate the safety and efficacy of this procedure.
METHODS: Fractional CO2 laser resurfacing was performed in conjunction with
incisional upper blepharoplasty. The ultrapulsed laser energy was applied to the 
sub-brow skin, the upper medial canthal skin, and the pretarsal skin in 30
patients. Photos were obtained preoperatively and at 3 months.
RESULTS: All patients demonstrated reduction in upper eyelid rhytidosis without
any serious complications. Independent rhytidosis grading (0-4) showed a mean
improvement of 42%. One patient experienced wound dehiscence that satisfactorily 
resolved without intervention.
CONCLUSIONS: Upper eyelid laser resurfacing is effective and can be safely
performed at the same time as upper blepharoplasty. This approach reduces or
eliminates the need for medial incisions to address medial canthal skin
redundancy and rhytidosis and it directly treats upper eyelid wrinkles on
residual eyelid and infra-brow skin during blepharoplasty.

PMID: 26505229   [PubMed - as supplied by publisher]